Provider Demographics
NPI:1629329743
Name:MCKENNA, JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:MCKENNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5517
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-5517
Mailing Address - Country:US
Mailing Address - Phone:630-742-7308
Mailing Address - Fax:877-525-7207
Practice Address - Street 1:600 W MADISON ST
Practice Address - Street 2:5TH FLOOR MCS
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-2406
Practice Address - Country:US
Practice Address - Phone:630-742-7308
Practice Address - Fax:877-525-7207
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046232202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner